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Mom's experience with Medicare part C

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Just one anecdote, and a mild one at that. I know: the plural of "anecdote" is not "data". So take it as you will.

My Mom is enrolled via Medicare part C in an HMO whose name will be changed to protect the people working for it who bent the rules a bit. I'll refer to it as MPCHMO. Mom is mostly pretty much happy with MPCHMO. Bear that in mind as you read.

Mom recently found herself suffering from a bewildering array of vague symptoms which were reducing her quality of life dramatically. Age-related? She decided to check it out.

"One thing I like about MPCHMO is that about half of their doctors are women. But my doctors keep leaving MPCHMO: I don't know why," she told me, recounting the story later on. [I could speculate...] "So I keep having to pick a new doctor. So when I found out that my last one was leaving, I asked her if she could recommend anyone. And she told me that they are not allowed to talk about other doctors.

"Can you imagine?" she asked. "I don't know how to choose a doctor."

I sympathized. "We've got to get the insurance companies out of this," I murmured. She agreed. Then she went on:

"Well, anyway, my doctor told me, 'Maybe you should talk to the nurses.' The nurses said, 'well, we're really not allowed to talk, but Dr. X's patients seem to be very happy.'" So my Mom decided to use Dr. X. And a good thing, too.

In a very Dr.-House-like manner, Dr. X managed to diagnose all of my Mom's varied and vague complaints as due to a hormonal imbalance caused by an overgrown gland. [I'm not using the medical terminology, but that's the gist of it.] The problems, which were seriously eroding my Mom's quality of life, could be easily treated by surgery to reduce the overgrown gland.

Now the problem was... to schedule the surgery.

This was not emergency surgery, but it was certainly urgent surgery. My Mom was having trouble concentrating, remembering, thinking clearly, just living her normal life. She was told that the surgery date would be scheduled within 3-4 weeks. Note: not that the surgery would take place within 3-4 weeks: but that she would received a phone call setting the date within that time.

When she told me this story, it had been three weeks. She was still hoping to hear from the scheduling department in the next week or so.

She was not scheduled during that next week, and in fact, she did not receive a date until she decided on her own to stop dealing with the scheduling department and called her doctor's office directly. She then received a surgery date - the surgery was to take place nearly seven weeks after she first received confirmation of the diagnosis.

Mom's now (thankfully) out of hospital and on the mend. But it was almost in spite of her insurer:

• She likes her PCPs (so far), but they keep leaving just when she's developed a relationship with them. [Would a new doc necessarily have known that Mom's symptoms were out of the norm for her, even at her age, and gone looking for another explanation? Would electronic medical records have contained that information?]

• The doctors are forbidden from making recommendations or referrals or even giving any information about other PCPs to help her choose a new one. [Thank goodness for the nurses!]

• And she still had to wait almost 7 weeks for needed surgery - a wait that might have been even longer if she had meekly followed directions and dealt only with the scheduling office.

Mom's still happy with her doctor. I hope this one sticks around awhile.

The bottom line, we all want choice: we want to choose our doctors and other health-care providers. We don't want to choose among a morass of confusing and expensive insurance plans.

(That last paragraph is almost a quote from someone here at Corrente, possibly a commenter, who said it a lot better. If you know who it was, please leave a comment here!)

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